Counseling’s impact on adherence to Antiretroviral Therapy among pregnant and breastfeeding women

Pregnant women living with HIV can transmit the infection to their babies in utero, during delivery or through breastfeeding. To help reduce the likelihood of this transmission, the WHO has implemented a targeted program for providing antiretroviral treatment (ART), titled Option B+. Adherence to ART through the Option B+ program is essential among pregnant women to preventing HIV re-infection, eliminating transmission to babies, and improving general wellbeing. 

One of the major factors that prevents patients from adhering to ART is the side effects associated with the medications, which can often be more commonly experienced among pregnant and breastfeeding women. Lack of knowledge about ART is also associated with non-adherence and lack of retention. In order to encourage adherence to ART, the WHO recommends health care providers counsel people living with HIV about the side effects and importance of the medications.

New research from Jerry Nutor interviewed and surveyed pregnant and breastfeeding women enrolled in Option B+ in Zambia, a country with one of the highest prevalence rates of HIV among pregnant women, to investigate the relationship between counseling and adherence to treatment. Researchers found that 75% of HIV+ women reported being adherent to Option B+. Those who received counseling prior to initiating ART were significantly more likely to report medication adherence. They also found a significant association between counseling and adherence among women from a rural district in Zambia, but not among those from an urban district. Overall, fewer women from the rural district were counseled prior to receiving ART, compared with those from the urban district. However, women from the rural district who were counseled were less likely to miss taking ART.

These findings show the importance of ensuring access to counseling prior to ART, especially in rural areas, as organizations and healthcare providers scale up the implementation of Option B+ and other treatment programs. These counseling efforts should make sure to include information about dosages, expected side effects and contraindications for ART. Providers should also strive to offer ongoing adherence support. Other mediums, such as educational flyers or radio programming, should also be used to communicate the important of adherence to ART and treatment of common side effects of ART, especially in rural areas.